PREOPERATIVE

AND

POSTOPERATIVE

CARE INCLUDING

FEEDING

PREPARATION
NOTED
IN

FOR SURGERY
NURSING
CLINICS

THE

OF NORTH AMERICA

IN

1967
AND
FOR

THE

PATIENT

SHOULD BE RELATIVELY

FREE

OF UPPER 10

RESPIRATORY

INFECTION

POSSESS

HEMOGLOBIN
ROUTINE

LEVEL OF AT LEAST

GM HE
OF LIQUIDS

SHOULD BE PREPARED
OR THE ASEPTO PRIOR

POSTOPERATIVE

BY BEING FED WITH

SPOON CUP

SYRINGE TO THE THE

BY VARIOUS
PALATE CHILD

PEOPLE USING
THE

GOOD VARIETY

TWO WEEKS

SURGERY

MOTHER CAN USE

NURSES

WHITE

CAP

AND GOWN TO PREPARE

FOR HOSPITAL

MACCOLLUM
AND ADULTS
IN

IN

THE

OLDER CHILDREN

WHOM BLEEDING
FOR 500

CAN

BE
IS

MORE EXTENSIVE
ADVISABLE

TYPE AND CROSSMATCHIN

ML

OF BLOOD

BUT SELDOM USED

POSTOPERATIVE
AGAIN
IT
IS

CARE
1967
THIS

AS

REMARKED IN

IMPORTANT TO REMEMBER THAT

IN

BABY HAS BEEN USED TO BREATHING SURGERY

THIS

WITH

HOLE

THE

ROOF OF HIS
IS

MOUTH

AFTER

HOLE

IS

CLOSED AND

NEW
EASILY

PATTERN OF BREATHING IN

NOW NECESSARY

THE ADJUSTMENT MAY NOT COME

ADDITION

THERE
LIE

MAY BE SOME OOZING OF BLOOD FROM THE OPERATIVE DOWN AND

SUCTION

SITE

THE
WITH

BABY SHOULD
ALERT

FACE

SHOULD BE AVAILABLE
IN THE

AT

BEDSIDE TEN

NURSING ATTENDANCE ELBOW

DISRUPTING

FOR SEVERAL DAYS PARTICULARLY RESTRAINTS THE ARE APPLIED PALATE

FIRST

HOURS FROM

HERE AGAIN
INADVERTENTLY

TO PREVENT

THE

PATIENT

HEALING

THESE RESTRAINTS ARE MAINTAINED

THREE WEEKS AT

HOME WITH

SHORT

PERIODS

OF CONTROLLED

FREEDOM BECAUSE OF

159

UNAVOIDABLE

AND CONTINUOUS
FIVE

CONTAMINATION
POSTOPERATIVELY OR

SYSTEMIC

ANTIBIOTIC

MAY BE

USED FOR THREE TO

DAYS

WITH

THE AID OF THE ASEPTO SYRINGE

CUP
IS

THE BABY

IS

FED LIQUIDS DRINK

THE FIRST

TWO WEEKS FOLLOWING SURGERY EACH WHICH

SERVES AS

FEEDING

FOLLOWED BY

OF WATER

MOUTHWASH DURING

THE NEXT

TWO WEEKS

THE BABY RECEIVES

SOUPY DIET

AT ONE MONTH
IS

REGULAR DIET EXCLUDING STRAWS ARE ALLOWED FOR

HARD FOOD SUCH AS TOAST COUPLE OF MONTHS FROM

AND ROCK CANDY

THE

BEGUN

NO

TIME

OF SURGERY

MORE DETAILS
AS AN
INTERN
AT

ON FEEDING
MEDICAL

BOSTON CHILDRENS
THE TRICK

CENTER

LEARNED FROM

DONALD MACCOLLUM
FOR CLEFT PATIENTS
IN

OF USING
IN

SPECIAL

FEEDING

TECHNIQUE

AS
THE

DESCRIBED

1967
IN HER LEFT

THE BABY

IS

HELD
IS

NURSES ARM WITH HIS HEAD HELD UPRIGHT THROUGH

10CC
IS

HAND FORMULA
WITH BABYS
THE INCH

FED BY BULB COMPRESSION

ASEPTO SYRINGE
SLIPPED OVER THE
AS

RUBBER CATHETER EXTENSION

IS

THE

CATHETER
IS

TONGUE AND THE FORMULA

HAS ADJUSTED TO THIS

FED AS THE BABY ROUTINE THE

ABLE TO TAKE IT
IS

AS SOON
IN THEY

BABY

MOTHER BY

INSTRUCTED

THE ARE

TECHNIQUE

ONCE MOTHER AND BABY

ARE PREPARED

THE

NURSE

ALLOWED TO GO

HOME

THE

BIFID

NIPPLE
NEW YORK
UNIVERSITY
BIFID REFLEX

KENNETH ADISMAN OF

HAS
CLEFT
IS

1957
PALATE

PATENT NIPPLE

ON

DOW CORNING COMPANY

SIGNED FOR THE INFANT

SILASTIC

DE

WHOSE SUCKING AND PALATE

IN

ABSENT

OR

MINIMAL

AS NOTED
THE
LIQUID

IN

CLEFT

FLOWS FROM THE BIFID THE

NIPPLE

STREAM THROUGH OPENINGS DIRECTED

SERVES TO PARTIALLY THE MAXILLARY

LATERALLY

AGAINST

CHEEKS THE FLARED TEAT HEAD WHICH

IS

CLOSE THE CLEFT

OPENING
THE

COMPRESSED BY TONGUE ACTION FROM THE

INFANTS THE

AGAINST BIFID IN THC

PROCESS EXPELLING
CONSTRUCTION POSITION

LIQUID THESE

NIPPLE

THIS WHILE

TYPE

OF NIPPLE
FCCDIIIG

ENABLCS FLUID
IS

TO SUCKLE NASAL CAVITY

SIZES

USUAL
CLEFT

WITHOUT
NIPPLE

ENTERING IN

THROUGH THE
TO

OPENING
SHAPED VENTING

THE
MAXILLARY

MADE THE

TWO

TO

CONFORM

DIFFERENT SUITABLE
IS

PROCESSES WILL

NIPPLES

MAY BE PROVIDED WITH

THE BOTTLE
AS

MEANS WHICH
THEREBY LIQUID

ALLOW AIR THE

TO TRICKLE INTO SUCTION

LIQUID

WITHDRAWN
FLOW OF

REDUCINGJ

REQUIREMENTS FOR

SATISFACTORY

160

NEW SQUIRT
HERE ING
IT
IS

ARE

BETTY JANE

MCWILLIAMS

THOUGHTS ON

CLEFT

PALATE

FEED

PERFECTLY
IF

TRUE THAT THE

BABIES

USUALLY

DO NOT GAIN

AS WELL

AS

WOULD BE
PLAN

HOPED

THE MOTHERS ARE LEFT COMPLETELY ALONE

TO DEVELOP

FEEDING

BY

TRIALANDERROR
LITTLE

METHOD UNFORTUNATELY
IS

WE RELUCTANTLY
NEWBORN

CONCLUDE THAT VERY AND THAT

THE

ASSISTANCE ARE OFTEN

PROVIDED IN
QUITE

THE

AVERAGE

NURSERY THE

NURSES

UNCOMFORTABLE ABOUT FEEDING

TO

INFANTS

AND ABOUT

PROVIDING

INSTRUCTIONS

NEW MOTHERS
FEEDING

WE WERE
TINY PLASTIC BAGS

USING

MORE COMPLICATED
DRUGSTORE

SYSTEM UNTIL

ONE EVENING

AT

NEIGHBORHOOD

PICKED UP AN EVENFLO

DISPOSABLE

NURSER

MD NIPPLES
PARADISE THE

TOOK THEM HOME AND EXPERIMENTED WAS TEACHING MOTHER

IT TRIED

NEXT MORN
TECHNIQUE

ING

PEDIATRICIAN

OUR OLD
IT

SQUIRTED

HIM WITH

NEW BOTTLE HE TOOK

AND TURNED TO THE

MOTHER AND SAID

FORGET

EVERYTHING THAT

IVE

SAID

WELL

USE

THIS

AND WE HAVE EVER SINCE

BABIES

THE SYSTEM
SIMPLE INDEED

WE FOUND

SUCCESSFUL

FOR MOST

WITH

CLEFTS

IS

VERY

HOLD
USE

THE

BABY IN

SITTING

POSITION
IN THE SIDES

PLASTIC

SHELL WITH BAGS

OPENINGS

AND WITH

NO BOTTOM

USE DISPOSABLE
IN THE

TO HOLD THE NIPPLE

IS

FORMULA
FOR PREMATURE INFANTS THE

BEGINNING
THE THE

USE

BE
CROSSCUT

SURE THAT PERMITS

OPENING MILK

CROSSCUT NEVER ENLARGE

HOLE THE
FOR

TO FLOW BUT ALSO PROVIDES INTO THE

GOOD MECHANISM

PREVENTING THE MILK

DISTRESS

FROM GUSHING

BABYS MOUTH AND CAUSING HIM

THE MOTHER SHOULD

THE

LEARN TO INSERT HER FINGERS

INTO

THE SIDE INTO

SLOTS AND THE BABYS

BOTTOM OPENING

SO THAT SHE CAN GENTLY

EXPRESS THE

MILK

MOUTHBEING
BURP
THE

CAREFUL CHILD

NOT TO PROVIDE MORE HELP

THAN THE

INFANT

NEEDS

FREQUENTLY FEEDING IN

ATTEMPT FOLLOW
FINGER

TO COMPLETE THE AVERAGE

NO MORE THAN
OF SOLIDS

HALF

HOUR

NORMAL

SCHEDULE

FOR THE

INTRODUCTION

INCLUDING

AND TABLE FOODS

EVENFLO ORDERED IN

DISPOSABLE QUANTITIES PLAYREX

NURSERS

ARE NOT ON THE

MARKET

NOW BUT MAY

OHIO
THE

BE
IN

FROM QUESTOR JUVENILE

PRODUCTS RAVENNA
QUITE WELL BY ENLARGING

ADDITION

NURSERS FINGER

MAY BE USED MAY BE

INSERTED

SLOTS

OF THE SIDES SO THAT

THE

BOTH OF THESE TECHNIQUES

PERMIT
IS

MOTHER TO USE EQUIPMENT THAN ARE MANY OF THE

THAT DOES NOT LOOK SPECIAL DEVICES

SPECIAL

AND THAT

MUCH

CHEAPER

161

IT

HAS ALWAYS BEEN

MY

FEELING

THAT

WELLPLANNED
PRECAUTIONS PALATE

CAREFUL
AS

SURGERY ARE

AND

SIMPLE

PRACTICAL

POSTOPERATIVE

NOTED 1971 HE

SUFFICIENT

TO ACHIEVE

WELLHEALED
APPROVAL
IN

WHEN IN

SAM EX

PRUZANSKY
PRESSED

WROTE

HIS

OF

CLEFT

CRAFT

VOLUME

DISAPPOINTMENT
THAT
HIS

THE

CHAPTER

POSTOPERATIVE AN EXPERT
IN
THIS

CARE
AREA

MENTIONING

WIFE

DONNA WAS

ALTHOUGH OUR
LEARNED

BABIES

WERE HEALING CRY

AND GAINING

WEIGHT LONG AGO

TO HEED

SAMS

FOR 10 YEARS OF MEDICINE

DONNA

PRUZANSKY

AT THE

ABRAHAM LINCOLN SCHOOL

IN

CHICAGO HAD BEEN

FOR

INVOLVED

NURSING OUTREACH

PROGRAM WHICH ARRANGED

THE VISITING ORAL FACIAL POTENTIAL DONNA PUZANSKY THE

CRITICAL

NUTSE TRAINED

IN

THE

COMPREHENSIVE
CRISIS

NEEDS

OF THE

CHILD

WITH AN

CLEFT TO PLAY AN IMPORTANT ROLE IN FCEDING

INTERVENTION

HY PLEVENRING
INTAKE

PROHIEMS

AND ASSURING THIS

CONTACT

ADEQUATE NUTRITIONAL
INSTRUCTION

DURING

NEONATAL

PERIOD

ENTAILS

OF THE

PARENTS THE

HOSPITAL
ISIRS

STAFF AND FOLLOW

UP

WITH THE MOTHER AND INCLUDING

HOME

WHERE REQUIRED

THESE

WERE SOME OF HER SUGGESTIONS

ONLY MINOR

MODIFICATIONS

OF THE USUAL TECHNIQUES HCGIN

USED

IN

HORTLE FEEDING

ARE OR

RCC
NIPPLE

ED TO FCCCI MOST NIPPLE

CLP HAHIE TO

WITH

EITHER
IS

PREMIE

NIPPLE

LAMH
IS

DAN OL INC
IN
ILL

PIOVIDENCE

RI

PREFERIED
LIP

THE LAMHS

NECESSARY NIPPLE THE

THE CASE OF NOR SLIP INTO

WIDE UNILATERAL
THE CLEFT RHTIS THE

CLEFT

AND PALATE SINCE

TO HIRE

THE HICAD

ALLOWING THE INFANT

STRIP

AGAINST

ALVEOLUS

AND

TISE

TONGUE TO
FOR

THE

MILK

FROM THE

NIPPLE

THIS

PROCESS OHX IARES

THE

NEED

FEEDING

OHRURATORS
THE NIPPLE

THE OPENING SHOULD HE

IS

ENLARGED CROSS CUR

TO FACILITATE
IS

FLOW TO DO THIS
SCALPEL

TURNED INSIDE
THE

OUT AND OPENING

IN

MADE WITH
RATHER

OR RAZOR HLADE THE

ENLARGING
DIAMETER

THIS

MANNER

THAN MERELY ENLARGING

TO CONTROL THE

OF THE HOLE IN THE NIPPLE

PERMITS OF COORDINATION

ALLOWS THE INFANT

FLOW OF

MILK THIS

OF SUCKING PATTERN

SWALLOWING ADEQUATE
FLOW

AND HREARHING
IS

AND

ESRAHLISHMENR

NORMAL FEEDING
PERIODS

EJIRICAL

TO AVOID HEFORE HE

UNDULY PROLONGED FEEDING CAN COMPLETE SUFFICIENT POKING

HOLES WITH

VHICH

WILL

EXHAUST THE INFANT

NIPPLE THE

INTAKE

IN

CONTRAST

OPENINGS
INFANT

ENLARGED

HY AND

HOT NEEDLE
INSERTION

RESULT IN

FLOODING

WITH MILK

NECESSITATE

CONRINRIOUS

AND WITHDRAWAL OF THE NIPPLE

TO ALLOW THE

BABY TO BREATHE THERE

IS

NO NEED TO HOLD THE INFANT

AS
IS

UPRIGHT
ADVISED

AIM
IN

THE MILK

AT

THE CHEEK

OR

BURP MORE FREQUENRB

SO

OFTEN

MANUALS

FOR PARENTS

162

HELPFUL SINCE

HINTS

THE
IT IS

LAMBS

NIPPLE

DOES NOT

FIT

ONTO CONVENTIONAL BOTTLES WITH MOST EFFECTIVE ARRANGEMENT

IS

SCREW

TOPS
BASE

NECESSARY

TO IMPROVISE

TO CUT THE

FROM

CONVENTIONAL NIPPLE ENGENDERED

BREAST FEEDING

AND USE
THE

IT

AS

AN ADAPTER
OFTEN DISCOURAGES BREAST FEEDING THE
IS

THE

ANXIETY

BY
IN

MALFORMATION

MOTHER FROM

OUR EXPERIENCE

SUCCESSFUL

CONTINGENT UPON
THE
CLEFT
IT

NUMBER OF VARIABLES
OF THE

THAT INCLUDE PREVIOUS FOR EACH

CLEFT
IS

THE TYPE AND SEVERITY EXPERIENCE

OF

AND THE DEDICATION

REQUIRES

MOTHER
OF TIME

HELPS EVEN

THEN

LONGER PERIOD
OF FEEDING

FEEDING

THE PROBLEM

AN INFANT

WITH

COMPLICATED BY THE ROBIN

IS

THE MAINTENANCE SYNDROME WHERE THE MICROGNARHIA AND GLOSSOPROSIS FURTHER AGGRAVATES THE

OF AN ADEQUATE AIRWAY

COMPROMISED

BY

THE

INTRODUCTION

OF THE NIPPLE

AND MILK

PROBLEM
SEVERITY

DEPENDING UPON
POSSIBLE

THE

OF THE CONDITION
IN

BOTTLE

FEEDING THE IN

MAY BE
AITWAY

WITH

CERTAIN

MODIFICATIONS IN

POSTUTING

TO MAXIMIZE

THIS

CAN BE ACHIEVED WITH

SOME

INSTANCES

BY HOLDING THE INFANT

THE

AN UPTIGHT

POSITION

MANUAL

ASSISTANCE

TO GUIDE

MANDIBLE
IN

FORWARD ON THE ROBIN

FEEDING CAN BE ACCOMPLISHED WITH THE INFANT NURSES LAP WITH HEAD EXTENDED
FEEDINGS
IS

THE PRONE POSITION

FOR THE

SEVETELY

COMPROMISED

SYNDROME

NASOGASTRIC

MAY BE

REQUIRED NEONATAL

ALTHOUGH
ASSURED THAT
AT

THE FOTEGOING

LIMITED

TO THE

PERIOD

PARENTS

CAN BE BABY

BABY FOODS AND TABLE FOODS CAN BE INTRODUCED TO THE

AS

CLP

THE
IT
IS

SAME AGE

FOR THE

NONCLEFT CHILD
CLEFT
IS FIRST

AN OBVIOUS BUT OFTEN OVERLOOKED FACT THAT THE BABY WITH

OF

ALL

BABY

LIKE

ALL

BABIES

THE

MA

SPIT

UP HA

ALLERGICS AND

NI

RIAD OF

LAMB
IT

OTHER
IS

PROBLEMS UNRELATED
TO EXAMINE

TO THE CLEFT THEREFORE THE HOLE CHILD

WHEN PIOBLEMS

DO ARISE

NIPPK

IMPORTANT

AND NOT FOCUS ONLY ON THE CLEFT

163